Improved measurement of racial/ethnic disparities in COVID-19 mortality in the United States

Abstract

Different estimation methods produce diverging accounts of racial/ethnic disparities in COVID-19 mortality in the United States. The CDC's decision to present the racial/ethnic distribution of COVID-19 deaths at the state level alongside re-weighted racial/ethnic population distributions -- in effect, a geographic adjustment -- makes it seem that Whites have the highest death rates. Age adjustment procedures used by others, including the New York City Department of Health and Mental Hygiene, lead to the opposite conclusion that Blacks and Hispanics are dying from COVID-19 at higher rates than Whites. In this paper, we use indirect standardization methods to adjust per-capita death rates for both age and geography simultaneously, avoiding the one-sided adjustment procedures currently in use. Using CDC data, we find age-and-place- adjusted COVID-19 death rates are 80% higher for Blacks and more than 50% higher for Hispanics, relative to Whites, on a national level, while there is almost no disparity for Asians. State-specific estimates show wide variation in mortality disparities. Comparison with non- epidemic mortality reveals potential roles for pre-existing health disparities and differential rates of infection and care.

Genetic Hypothesis and Pharmacogenetics Side of Renin-Angiotensin-System in COVID-19

“…Nevertheless, it has been reported that Europe experienced the highest CFR (9.6%), followed by North America (5.9%) and Asia, this last showing the lowest value (3.5%) despite the pandemic having spread from China [ 27 , 110 , 111 ]. Interestingly, place- and age-adjusted CFR evaluations in USA, comparing Blacks, Whites, Hispanics and Asians, ascribed to Blacks the highest CFR in crude-, place-, age- and age/place-adjusted analyses, suggesting gene–environment interactions and ethnic disparities, having compared different ethnicities living in the same country [ 112 , 113 ]. Nevertheless, the apparent difference in disease fatalities between countries, central Europe and East Asia, or in the same country among different ethnicities as reported in US, suggests different possible explanations should be taken into account.…”

“…In addition, multiple viral infections and the involvement of associated immuno-virological factors or potential coronavirus resistance gene mutations occurring among East Asians as a result of long-term co-evolution of the virus and host cannot be excluded [ 65 ]. Finally, the existence of health inequities among minority populations unmasked how the pandemic greatly affects the most socially and economically disadvantaged people/gender but paradoxically, also countries with universal health coverage are not able to completely protect its inhabitants against high CFR due to COVID-19 pandemic [ 2 , 110 , 112 , 113 , 114 ].…”

What the HIV Pandemic Experience Can Teach the United States About the COVID-19 Response

“… 36 Across the United States, COVID-19 mortality rates are 80% higher for Blacks and over 50% higher for Latinx relative to Whites. 37 COVID-19 data for disadvantaged populations are currently limited to outbreaks in concentrated settings, but these highlight emerging disparities among people who are incarcerated and unstably housed or homeless. 38 – 40 …”

Association Between Ethnicity and Severe COVID-19 Disease: a Systematic Review and Meta-analysis

“…There were 12 US-based ecological design studies, utilising publicly available dataset to draw an indirect association between ethnicity and COVID-19 outcomes. Eight studies illustrated that counties with a greater proportion of African-Americans have higher rates of countylevel COVID-19 hospitalisations and deaths [28][29][30][31][32], even after adjusting for a combination of county-level characteristics such as age, poverty, comorbidities, healthcare access and geography [33][34][35][36]. One study did not find an increased mortality risk in Asian ethnicity after adjustment for age and geography [35].…”

“…Instead, a higher proportion of Asian population was a protective factor to counties [32]. Three studies reported increased age-adjusted mortality in the Hispanic population [32,[35][36][37]. One study noted that ethnic segregation correlated with risks of COVID-19 death [38].…”